Modalités et voies préférentielles de propagation géographique du choléra à partir des zones endémiques de l'est de la République démocratique du Congo

Cholera is endemic along the Great Lakes Region, in eastern Democratic Republic of the Congo (DRC). From these endemic areas, also under perpetual conflicts, outbreaks spread to other areas. However, the main routes of propagation remain unclear. This research aimed to explore the modalities and likely main routes of geographic spread of cholera from endemic areas in eastern DRC. We used historical reconstruction of major outbreak expansions of cholera since its introduction in eastern DRC, maps of distribution and spatiotemporal cluster detection analyses of cholera data from passive surveillance (2000-2017) to describe the spread dynamics of cholera from eastern DRC. Four modalities of geographic spread and their likely main routes from the source areas of epidemics to other areas were identified: in endemic eastern provinces, and in non-endemic provinces of eastern, central and western DRC. Using non-parametric statistics, we found that the higher the number of conflict events reported in eastern DRC, the greater the geographic spread of cholera across the country. The present study revealed that the dynamics of the spread of cholera follow a fairly well-defined spatial logic and can therefore be predicted

Cholera in the Lake Kivu region (DRC): Integrating remote sensing and spatially explicit epidemiological modeling

Mathematical models of cholera dynamics can not only help in identifying environmental drivers and processes that influence disease transmission, but may also represent valuable tools for the prediction of the epidemiological patterns in time and space as well as for the allocation of health care resources. Cholera outbreaks have been reported in the Democratic Republic of the Congo since the 1970s. They have been ravaging the shore of Lake Kivu in the east of the country repeatedly during the last decades. Here we employ a spatially explicit, inhomogeneous Markov chain model to describe cholera incidence in eight health zones on the shore of the lake. Remotely sensed data sets of chlorophyll a concentration in the lake, precipitation and indices of global climate anomalies are used as environmental drivers in addition to baseline seasonality. The effect of human mobility is also modelled mechanistically. We test several models on a multiyear data set of reported cholera cases. The best fourteen models, accounting for different environmental drivers, and selected using the Akaike information criterion, are formally compared via proper cross validation. Among these, the one accounting for seasonality, El Niño Southern Oscillation, precipitation and human mobility outperforms the others in cross validation. Some drivers (such as human mobility and rainfall) are retained only by a few models, possibly indicating that the mechanisms through which they influence cholera dynamics in the area will have to be investigated further. Key Points Markov chain model of cholera dynamics in the Lake Kivu area (DRC) Global climate anomalies are the main drivers, together with rainfall The influence of mobility and remotely sensed chlorophyll a were also teste

Lakes as Source of Cholera Outbreaks, Democratic Republic of Congo

We studied the epidemiology of cholera in Katanga and Eastern Kasai, in the Democratic Republic of Congo, by compiling a database including all cases recorded from 2000 through 2005. Results show that lakes were the sources of outbreaks and demonstrate the inadequacy of the strategy used to combat cholera

COVID-19 as an Accelerator of the Implementation of Emergency Medical Teams Initiative in the AFRO Region

Objective: This study describes the progress that the World Health Organization (WHO) African (AFRO) region has made in establishing National Emergency Medical Teams (N-EMTs), the coordination mechanisms of the EMTs, and the regional training centers. Methods: It used a retrospective descriptive analysis of the formulation and implementation of the EMTs Initiative from an insider perspective. The analysis is based on the review of available documents such as EMTs mission reports, assessments, surveys, EMT monthly bulletins, and meeting minutes in addition to key informant interviews (n = 5) with the EMT teams’ members to validate the findings and share field experiences. Results: The emergence of coronavirus disease 2019 (COVID-19) acted as an accelerator for the implementation of the EMT initiative in the AFRO region. A total of 18 EMT deployments were carried out in 16 countries in the AFRO region through the WHO EMT-network during COVID-19, providing support to countries in managing severe and critical COVID-19 cases. Conclusions: A Regional Training Center for N-EMTs is being set up in Addis Ababa to train the N-EMTs and strengthen local capacity of health personnel in the region. Challenges include unavailability of mentors to support countries in implementing N-EMTs and the Regional Simulation Training Center, poor funding, and coordination in the rolling out of the N-EMTs

The role of emergency medical teams in Eswatini during the COVID-19 pandemic

The paper documents experiences and lesson learned in responding to COVID-19 pandemic in Eswatini with the support of the Emergency Medical Teams. WHO databases, operation reports and hospitalization records were reviewed. The WHO Emergency medical Teams built the capacity for the local response teams in Eswatini. The conclusion is that following the intervention of the WHO Emergency Response Teams, Eswatini is better prepared to respond to the ongoing COVID-19 pandemic and future outbreaks

The emergency medical teams initiative in the WHO African region: a review of the development and progress over the past 7 years

Background: The WHO Emergency Medical Teams (EMT) Initiative coordinates the deployment of qualified medical teams who promptly respond to public health emergencies (PHEs) and provide quality service during emergencies whilst strengthening capacity. Globally, 40 EMTs have been classified between 2016 and the present (as of the writing of this article in December 2023) and are from across all the WHO regions except the WHO Africa Region (AFRO). However, WHO Africa has prioritised the implementation of EMTs in 10 priority countries to address the public health emergencies (PHEs) affecting the region. Objective: This article describes the development and progress of national EMTs in the WHO African Region over the past 7 years and elucidates the main lessons learned and the complexity and challenges in the process. Methods: This study employed a case study approach because of its appropriateness in examining a complex social phenomenon in a socio-political context in depth, using multiple lenses simultaneously. Data and information were obtained through document reviews and key informant interviews (KIIs) (n = 5) with the members of the EMT Initiative on shared field experiences. Data were systematically analysed using the Stages of Implementation Completion (SIC) framework, and the lessons learnt were presented using components of a framework from Adini et al. Results: The Initiative commenced in the WHO African Region following its launch in December 2017 in Senegal. The assessments of the concept’s engagement (involved learning and deciding), feasibility (reviewing expectation and capacity), and readiness planning (collaborating and preparing) showed that the context-specific (African context) challenges, lessons from different emergency response actions mainly guided the Initiative’s pre-implementation phase in the region and prompted the WHO emergency leadership on the urgency and need for the EMT concept in the region. The assessment of the implementation processes showed progress in key areas, with staff demonstrating improved competency, EMT services maintaining high fidelity, effective consultation launching critical components, and ongoing services providing successful support and monitoring. Creating the N-EMTs and revitalising the EMT concept required an aligned strategy with other regional emergency programmes and a futuristic vision. Proposed sustainability and governance components include creating N-EMT, developing a coordination structure, collaborating with partners, and finalising the N-EMT. Conclusion: The Initiative is an imperative component that would allow better-targeted management of health emergencies in the region. The continuous refinement of the EMT initiative is crucial. There is a need to work on additional components, such as a context-specific framework for collaborations and partnerships that would enhance deployment and procurement modalities and the complementarity between other regional initiatives to improve the work. Emphasis should be placed on strengthening local health systems, enhancing training and capacity-building programmes, and fostering regional and international collaborations. Additionally, sustainable funding and resource allocation are essential to ensure the resilience of EMTs in the African region and their long-term success

Dynamique des épidémies de choléra dans la région des grands lacs africains: cas de la République Démocratique du Congo

Cholera is a contagious diarrhoeal disease affecting only human, caused by Vibrio cholerae, a gram-negative bacillus. The disease results in profuse watery diarrhoea sometimes accompanied by vomiting, occurring after a few hours or a few days after the ingestion of food or water soiled by V. cholerae. In the environment, Vibrio cholerae is found in brackish water of estuarine zones where it colonizes the surface of algae and copepods, persisting in the absence of men for prolonged periods of time. So is the situation in the estuarine zones of South-East Asia such as the Bay of Bengal where the disease is known since the highest antiquity. After having been relatively spared by the first six pandemics, continental Africa was stroke in 1970 by the spread of the 7th pandemic of cholera. Since this date, according to the World Health Organization (WHO), more than 90 % of the cases of cholera were reported by Sub-Saharan African countries. Among them, the Democratic Republic of Congo (DRC) is one of the most affected countries. In DRC, from 2000 to 2008, 208,875 cases and 7,335 deaths (case fatality rate: 3.51 %) of cholera were reported to WHO, that is to say about 15 % of the cases and 20 % of the deaths observed worldwide during the same period. These cholera cases were mostly notified in the provinces of the East of the DRC, next to the African Great Lakes area. After more than 30 years of fight against cholera in DRC, an epidemiological study of the dynamics of cholera was set up in this country in order to better understand the epidemic factors of recurrence and to perform adjustments for the operational approaches. The main results of this research work have highlighted that less than 10 % of the health zones, all bordering lakes located in the East of the DRC, play the role of sanctuary zones for cholera. These results have also highlighted the seasonal variations of cholera, with fewer cases during the dry season, and the specific role of the fishermen populations, tradesmen and traditional minors in the restarts and diffusion of cholera epidemics. It was also shown that the cholera is not endemic all over of the East of the DRC. Overall, functioning of cholera in this area of Africa is mostly unstable, with epidemic flare-ups followed by relatively prolonged phases of extinction; this behaviour of cholera and its epidemic flare-ups is therefore characterized by a metastable state. However, it was also shown that some areas, namely Kalemie and Goma areas, functioning until there on a metastable mode have now changed for some years for an endemic mode. On the basis of these results, the implementation of a project of fight against cholera was recommended which aims to eliminate this disease from the whole DRC. This plan will concentrate the fight on the seven identified sanctuaries zones, giving priority to drinking water supply among the ranges of existing means of fight. The first actions implemented on the pilot site of Kalemie have yet modified the dynamics of cholera in this area. Indeed during the phase of intensification of the water supply activities in Kalemie the number of suspected cholera cases dramatically decreased while microbiological tests showed that the few remaining diarrhoeas cases were due to bacteria other than Vibrio cholerae. The epidemiology of cholera, as we observed it in the African Great Lakes area is different from the one described in South-East Asia estuarine zone. Even if several questions remain unsolved, such as the role of the lakes as a reservoir of V. cholera strains, -18- the results of this work open a new hope on the revival of the fight against this neglected disease.Le choléra est une maladie diarrhéique contagieuse strictement humaine, causée par Vibrio cholerae, un bacille gram négatif. La maladie se traduit par une diarrhée acqueuse profuse parfois accompagnée de vomissements survenant quelques heures à quelques jours après l'ingestion d'eau ou d'aliments souillés par V. cholerae. Dans l'environnement, V. cholerae est retrouvé dans les eaux saumâtres des zones d'estuaire où il colonise la surface de certaines algues et de copépodes, pouvant ainsi persister en l'absence de l'homme pendant des périodes de temps prolongées. C'est le cas dans les zones estuariennes d'Asie du Sud-Est telle que la région du golfe du Bengale, où la maladie est connue depuis la plus haute antiquité. Après avoir été relativement épargnée par les six premières pandémies, l'Afrique continentale a été frappée par la 7ème pandémie en 1970. Depuis cette date, selon l'Organisation Mondiale de la Santé (OMS), plus de 90 % des cas de choléra sont rapportés par l'Afrique sub-saharienne. La République Démocratique du Congo (RDC) fait partie des pays les plus touchés. En RDC, de 2000 à 2008, 208 875 cas et 7 335 décès (létalité de 3,51%) dus au choléra ont été notifiés à l'OMS, soit 15 % des cas et 20 % des décès rapportés dans le monde pour la même période. Ces cas de choléra touchent essentiellement les provinces de l'est de la RDC, situées dans la région des grands lacs. Après plus de trente ans de lutte contre le choléra en RDC, une étude épidémiologique de la dynamique du choléra a été initiée dans ce pays dans le but de comprendre les facteurs de récurrence épidémique et de proposer des ajustements sur les approches opérationnelles. Les principaux résultats de ce travail de recherche ont permis de mettre en évidence qu'à peine 10 % des zones de santé, toutes situées à proximité des lacs de l'est de la RDC, jouent le rôle de zones sanctuaires pour le choléra. Ces résultats ont également permis de mettre en évidence la saisonnalité du choléra, avec moins de cas en saison sèche, et le rôle spécifique des populations de pêcheurs, de commerçants et de mineurs artisanaux dans l'émergence et la diffusion des épidémies de choléra. Il a également été démontré que le choléra n'est pas endémique dans toutes les régions de l'est de la RDC. Le fonctionnement du choléra dans cette région d'Afrique est globalement instable avec des flambées épidémiques suivies de phases d'extinction relativement prolongées, les flambées épidémiques se produisant selon un mode métastable lorsqu'on considère l'Est de la RDC dans son ensemble. Cependant, il a aussi été montré que certains foyers fonctionnant jusque-là sur un mode métastable sont, depuis quelques années, passés à un fonctionnement endémique. C'est le cas des foyers de Kalemie et de Goma. Sur la base de ces résultats, il a été recommandé la mise en place d'un projet de lutte contre le choléra avec pour objectif d'éliminer cette maladie de l'ensemble de la RDC. Ce plan vise à concentrer les efforts de lutte sur les sept foyers sanctuaires identifiés en privilégiant les apports en eau potable parmi l'éventail des moyens de lutte existant. Lorsque les premières actions ont été mises en oeuvre sur le site pilote de Kalemie, nous avons constaté une diminution importante de l'incidence du choléra, tandis que les examens microbiologiques ont confirmé que les quelques cas de diarrhée encore rapportés à Kalemie n'étaient plus dus à V. cholerae mais à d'autres bactéries. L'épidémiologie du choléra telle que nous l'observons dans la région des Grands Lacs africains est différente de celle décrite en zone estuarienne d'Asie du Sud-Est. Même si plusieurs questionnements subsistent concernant les modes de persistance du choléra dans les zones lacustres ou la pérennité du V. cholerae dans les eaux des lacs, les résultats de ce travail sont porteurs d'un nouvel espoir pour la relance de la lutte contre cette maladie négligée

One Health and the African Great Rift

International audienceThe One Health concept initiated at the beginning of the century as the “One World One Health” initiative, has many roots historically and has been given plenty of definitions and populates a constellation of related concepts (ecohealth, planetary health, global health, environmental health, etc.). It has gained momentum with the increasing frequency of disease emergence and pandemics and the failure of traditional public health approach and biosecurity to prevent them. This had led WHO, WOAH, FAO and UNEP to jointly propose a “new definition (of One Health) for a sustainable and healthy future” (OHHLEP et al., 2022). However, there is still a long road ahead to fully integrate the multiple disciplines and concepts, to organize governance making their implementation possible in the field, and to subsequently mobilize sufficient manpower and appropriate funding (Destoumieux-Garzón et al., 2018; Giraudoux et al., 2022). Here we discuss the challenges posed by the increasing emergence of human, animal and ecosystem health issues and how a nexus approach of those issues is necessary (see IPBES (2020) and ongoing nexus assessment 2022-2024, IPBES (2019)). This applies to a large number of human health issues in the African Great Rift, those known (e.g. Ebola disease, Monkeypox, Malarias, Cholera, Echinococcoses, etc.) as well as those still unknown and incubating, whose origin and expansion combine with the deterioration of local socioecosystems.Destoumieux-Garzón, D., Mavingui, P., Boetsch, G., Boissier, J., Darriet, F., Duboz, P., Fritsch, C., Giraudoux, P., Le Roux, F., Morand, S., Paillard, C., Pontier, D., Sueur, C., Voituron, Y., 2018. The One Health Concept: 10 Years Old and a Long Road Ahead. Front. Vet. Sci. 5. https://doi.org/10.3389/fvets.2018.00014Giraudoux, P., Besombes, C., Bompangue, D., Guégan, J.-F., Mauny, F., Morand, S., 2022. One Health or One Health washing: an alternative more than ever to overcome. CABI One Health 1–4. https://doi.org/10.1079/cabionehealth20220006IPBES, 2020. Workshop Report on Biodiversity and Pandemics of the Intergovernmental Platform on Biodiversity and Ecosystem Services. IPBES, Bonn, Germany. https://doi.org/10.5281/zenodo.4147317IPBES, 2019. Nexus assessment [WWW Document]. IPBES Secr. URL https://ipbes.net/node/35931 (accessed 9.15.22).OHHLEP, Adisasmito, W.B., Almuhairi, S., Behravesh, C.B., Bilivogui, P., Bukachi, S.A., Casas, N., Becerra, N.C., Charron, D.F., Chaudhary, A., Zanella, J.R.C., Cunningham, A.A., Dar, O., Debnath, N., Dungu, B., Farag, E., Gao, G.F., Hayman, D.T.S., Khaitsa, M., Koopmans, M.P.G., Machalaba, C., Mackenzie, J.S., Markotter, W., Mettenleiter, T.C., Morand, S., Smolenskiy, V., Zhou, L., 2022. One Health: A new definition for a sustainable and healthy future. PLOS Pathog. 18, e1010537. https://doi.org/10.1371/journal.ppat.101053

Dynamique des épidémies de choléra dans la région des grands lacs africains (cas de la République Démocratique du Congo)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

Elimination of cholera transmission

No abstract availabl